ICU脓毒性休克患者发生急性皮肤衰竭风险预测模型构建及验证  

Construction and evaluation of risk prediction model for acute skin failure occurring in patients with septic shock in intensive care unit

作　　者：王敏娜[1] 马佳佳[1] 陈东莉[1] 张蜜 韩娟[1] 李洁琼[1] 吴永兴 WANG Minna;MA Jiajia;CHEN Dongli;ZHANG Mi;HAN Juan;LI Jieqiong;WU Yongxing(Department of Critical Care Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院重症医学科,西安市710061

出　　处：《护理管理杂志》2024年第7期586-590,613,共6页Journal of Nursing Administration

基　　金：国家自然科学基金(82103262);西安交通大学第一附属医院科研发展基金(2021HL-33)。

摘　　要：目的构建ICU脓毒性休克患者发生急性皮肤衰竭风险预测模型。方法选取2020年1月至2022年1月某医院ICU收治的491例脓毒性休克患者临床资料,单因素和多因素分析筛选出ICU脓毒性休克患者发生急性皮肤衰竭的影响因素,基于影响因素构建预警模型并验证模型的预测效果。结果491例ICU脓毒性休克患者发生急性皮肤衰竭71例(14.46%)。体表面积(OR=38.030)、国家早期预警评分(OR=2.457)、序贯器官衰竭评分(OR=4.018)、动脉血乳酸值(OR=7.404)、外周灌注指数(OR=0.003)、毛细血管再充盈时间(OR=36.864)均为ICU脓毒性休克患者发生急性皮肤衰竭的影响因素(P<0.01或P<0.05)。基于上述影响因素建立预测模型和绘制列线图,模型ROC曲线下面积为0.964,最大约登指数对应的风险预测值82.71%,预测临界值评分为≥233分,Hosmer-Lemeshow拟合优度检验χ2=0.586,P=0.996,模型校准曲线的实际曲线与理想曲线几乎重合。结论基于ICU脓毒性休克患者发生急性皮肤衰竭风险因素构建的列线图预测模型具有良好的一致性与区分度,风险预测值评分为≥233分,为ICU脓毒性休克患者发生急性皮肤衰竭风险预警与防治提供依据。Objective To construct a risk prediction model for acute skin failure occurring in patients with septic shock in ICU.Methods The clinical data from 491 patients with septic shock in ICU of a hospital from January 2020 to January 2022 was selected.The influencing factors of acute skin failure in patients with septic shock in ICU were screened out by univariate and multivariate analysis.The early warning model was constructed based on influencing factors and the predictive effect of the model was verified.Results Acute skin failure occurred in 71(14.46%)of 491 patients with septic shock in ICU.Body surface area(OR=38.030),national early warning score(OR=2.457),sequential organ failure assessment score(OR=4.018),arterial lactate value(OR=7.404),peripheral perfusion index(OR=0.003),and capillary refill time(OR=36.864)were all influencing factors of acute skin failure occurring in patients with septic shock(P<0.01 or P<0.05).The prediction model was built based on above influencing factors and the nomogram was drawn.The area under ROC was 0.964,and risk prediction value corresponding to the maximum Youden index was 82.71%.The predicted critical score was≥233 points,while Hosmer-Leme showed that the goodness of fit test was 2=0.586,P=0.996.Actual curve of calibration curve almost coincided with the ideal curve in model.Conclusion In the study,based on the risk factors of acute skin failure in patients with septic shock in ICU,the nomogram prediction model has good consistency and differentiation,and the predicted risk value score is≥233 points,providing reference for risk warning and prevention of acute skin failure in patients with septic shock in ICU.

关 键 词：急性皮肤衰竭 脓毒性休克 重症监护室 风险预测模型 护理 

分 类 号：R473[医药卫生—护理学]